Provider Demographics
NPI:1942299086
Name:REID, K JOE (MD)
Entity Type:Individual
Prefix:
First Name:K
Middle Name:JOE
Last Name:REID
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2323 W ROSE GARDEN LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-2530
Mailing Address - Country:US
Mailing Address - Phone:623-931-7999
Mailing Address - Fax:623-842-5640
Practice Address - Street 1:2323 W ROSE GARDEN LN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-2530
Practice Address - Country:US
Practice Address - Phone:623-931-7999
Practice Address - Fax:623-842-5640
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ132232085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ244161Medicaid
AZ30WCFHS13Medicare PIN
E00216Medicare UPIN
AZ244161Medicaid